More than half of NHS junior doctors who responded to a survey on the effects of fatigue on anaesthetic trainees have experienced an accident or near miss when driving home after a night shift.

The findings of the survey, published today in the journal Anaesthesia, also revealed how many trainees describe falling asleep at the wheel, being woken by rumble strips and having ‘microsleeps’ while driving.

The study, entitled A national survey of the effects of fatigue on trainees in anaesthesia in the UK found that many of the 2,231 respondents reported having accidents ranging from minor bumps and scrapes to significant incidents resulting in their car being written off.

One of the authors, Dr Laura McClelland, specialist trainee in anaesthesia at University Hospital Wales, described how trainees frequently risk their lives travelling home from a night shift.

She said: “Fatigue among shift-working doctors is a huge problem. By minimising the likelihood and impact of tiredness, the safety of patients, doctors and the general public will be better protected.

“We have a collective duty to ensure that doctors are allowed to rest adequately in order to promote wellbeing and ensure they perform optimally both within their clinical environment and when travelling between shifts.”

Multiple adverse incidents were also reported in the survey by cyclists and walkers and nearly nine out of ten trainees used caffeine as a stimulant to counteract the effects of fatigue.

Chair of the Group of Anaesthetists in Training at the Association of Anaesthetists of Great Britain and Ireland (AAGBI) Dr Emma Plunkett said:

“This report highlights the need for action to address the widespread impact of fatigue and shift working on the lives of anaesthetic trainees. Rest facilities for doctors working nights are often not available either during or between shifts and even when they are, many trainees are unaware of them or do not use them.

“As a result of this study, the AAGBI is working to raise awareness of the importance of good sleep habits and strategies to help doctors manage working night shifts. We want departments to work with doctors to find ways to create suitable facilities, and to promote the use of those available. We have put together a package of resources to help with this.”

In the accompanying editorial, Dr Mike Farquhar, consultant in sleep medicine at the Evelina London Children’s Hospital, said the survey ‘paints a stark picture of how prevalent fatigue is amongst those our system depends upon; how high a toll it exacts, both professionally and personally.’

He said: “The NHS is characterised by employees who will willingly give of themselves and work in excess of what they are formally expected to, but we must acknowledge that this attitude can jeopardise performance, and challenge the culture that permits it – particularly when, as so often, critical decisions are at stake.

He added: “Addressing that challenge is difficult. At Evelina London, practical steps, including mandatory teaching at induction on sleep and shiftworking, and a Trust-wide campaign on the importance of breaks, are beginning to change the way we must think about fatigue to deliver effective, efficient NHS care safely for both patients and staff.”

ENDS

Fact box

Nearly three quarters of respondents reported fatigue having effects on their physical health or psychological well-being

More than two thirds reported effects on personal relationships

More than three quarters use a car or motorcycle to get to work, with nearly half using motorway as part of their commute

More than eight out of ten respondents stated that they have been too tired to drive home after a night shift

Less than a third were aware whether their hospital had rest facilities, with less than two out of 10 having ever used such a facility

Anaesthesia is the journal of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) the professional membership organisation for over 11,000 anaesthetists in the UK and Ireland.

The AAGBI promotes patient care and safety, and advances anaesthesia through education, publications, research and international work, as well as the professional aspects of the specialty. The AAGBI’s motto in somno securitas (safe in sleep) encapsulates the major focus of the AAGBI: safety in anaesthesia http://www.aagbi.org

The AAGBI has established a Fatigue Task Group, as a collaborative initiative involving members of both the AAGBI and RCoA trainee committees with senior representatives of the AAGBI and RCoA and other partner organisations. The research forms a key part of the AAGBI’s campaign to address the culture surrounding doctor fatigue in hospitals and tackle the problem of excessive fatigue, which is known to impair decision making, with consequences for both doctors and their patients.

The authors of this research will also be speaking about the findings on 5 July 2017 at the AAGBI’s Group of Anaesthetists in Training’s Annual Scientific Meeting (ASM).

At the ASM 2017 the AAGBI will also be promoting the publication of educational information to raise awareness of fatigue in hospitals, how to spot it and how to address it.

The survey was sent to 3,772 anaesthetic trainees, with a response rate of 57.5%